| NPI | 1972566206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA RN00156286) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30007165) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2013-06-14 |